Provider Demographics
NPI:1396842324
Name:CORVERA, JOSE BIGOL (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:BIGOL
Last Name:CORVERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 FOX KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2847
Mailing Address - Country:US
Mailing Address - Phone:410-252-1733
Mailing Address - Fax:410-252-0455
Practice Address - Street 1:9 FOX KNOLL CT
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2847
Practice Address - Country:US
Practice Address - Phone:410-252-1733
Practice Address - Fax:410-252-0455
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0015082207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB70196Medicare UPIN